Introduction

Primary care providers soon recognize that management of low back pain is common and complex. Low back pain is one of the most common reasons for physician visits in the United States and about one-fourth of all US adults report low back pain in the last three months. Furthermore, acute low back pain complaints oftentimes become chronic ones. Fortunately, our understanding of the physiology of pain and its treatment has increased dramatically in recent years. For example:

We now know that the use of opioids for chronic non-cancer back pain is counterproductive.

We know that advanced imaging of patients without dangerous “red flag” symptoms and signs is counterproductive.

We know that keeping a patient with low back pain active is essential.

Fortunately, many tools have recently been developed to assist providers as they approach their patients with back pain. The goal of this clinical update is to help introduce members of health care teams to these resources.

At 12 months there was no difference between the two groups for either outcome

The opioid group had significantly more side effects

For Chronic Pain, opioids offered no benefit over non-opioid medications for function or pain intensity and had significantly more side effects

The significance of this study is that for chronic pain, opioids didn’t provide any benefit over non-opioid in terms of function or pain intensity and carry significant risks. All decisions in medicine involve balancing risk and benefit. The SPACE trial showed that when it comes to opioids and chronic low back and degenerative hip and knee pain, there is no benefit, only risk.